gastrointestinal Flashcards
if a pt has primary sclerosing cholangitis, what would indicate a decrease in the synthetic function of the liver and the need for a liver transplant
prolonged PT
which demographic and syndrome is primary biliary cholangitis associated with
middle aged females
sjogrens syndrome
what is Wilsons disease and what is it characterised by
hepatic jaundice due to excessive copper deposition in liver / brain / cornea
characterised by
- reduced serum caeruloplasmin
- reduced total serum copper
causes psychiatric problems - speech/swallowing/physical coordination
which clinical sign is associated with raised oestrogen in cirrhosis
palmar erythema
which clinical sign is associated with portal hypertension in cirrhosis
caput medusae
what is terlipressin used for
treatment of bleeding oesophageal varicies
what is the cause of jaundice in the presence of deranged liver function tests and anti mitochondrial antibodies
primary biliary cholangitis
what is given before the administration of glucose in wernickes encepahlopathy
IV thiamine
what is used when there’s reduced consciousness due to cerebral oedema in hepatic encephalopathy
IV mannitol
what helps to reduce encephalopathy by facilitating nitrogenous waste loss through the intestines
lactulose
what is used to reduce oedema or ascites in liver cirrhosis
spironolactone
what are the most common bacteria associated with spontaneous bacterial peritonitis
e coli
k pneumoniae
prophylactic treatment for spontaneous bacterial peritonitis
Abx: ciprofloxacin or norfloxacin
what s the initial investigation if see someone unstable and confused, smelling of alcohol and has signs of liver failure
blood glucose - to rule out hypoglycaemia
then do LFTs
What is disulfiram used for
Is an aldehyde dehydrogenase inhibitor used in patients with alcohol dependency
Causes unpleasant symptoms on alcohol consumption which helps them abstain from drinking
If a patient has hepatic encephalopathy which medication can reduce confusion
Lactulose
- chlordiazepoxide is for pts at risk of alcohol withdrawal and is CONTRAINDICATED in pts with hepatic encephalopathy
what is Gilbert’s disease
benign condition (no treatment needed) in which there is decreased activity of the enzyme that conjugates bilirubin
this means you get unconjugated hyperbilirubinaemia during fasting, stress, exercise, illness
likely diagnosis if someone gets jaundice in ramadan
gilbert’s disease
what is the most common complication of acute liver failure
bacterial infection
which antibiotics should be avoided when treating HAP in a pt with acute liver failure and why
gentamicin - can cause renal failure
which resp condition requires needle decompression
tension pneumothorax
when would you give FFP
if there is evidence of haemorrhage / bleeding
when is IV mannitol given
if suspected raised intracranial pressure
treatment if pt has bibasal crepitations on inspiration
IV furosemide - as they have pulmonary oedema
which symptom specifically indicates primary biliary cirrhosis
pruritus
which antibiotic can cause jaundice
co amoxiclav
what does dry cough and red nodules on shin indicate
sarcoidosis
what does the triad of abdominal pain, ascites, tender hepatomegaly indicate
Budd Chiai syndrome - thrombosis of hepatic vein
what is the most likely diagnosis for an older pt presenting with anaemia, dyspnoea, palpitations, headaches, easy bruising, bone pain, splenomegaly
myelofibrosis
main treatment for confusion due to hepatic encephalopethy
ORAL lactulose
what is given for symptomatic relief of alcohol withdrawal
chlordiazepoxide
what is given to prevent wernickes encephalopathy
IV thiamine
what does a cloudy ascitic fluid tap indicate
infection
an INR over which number is indicative alone for urgent liver transplant
INR > 6.5
what is the triad of acute liver failure
encephalopathy
jaundice
coagulopathy
what causes leuchonychia in chronic liver disease
hypoalbuminaemia
what causes excoriations/pruritis in chronic liver disease
raised serum bilirubin
what ammonia levels are seen in liver failure
high
medication used to reduce recurrence of hepatic encephalopathy
rifaximin
3 meds for hepatic encephalopathy and what they’re used for
oral lactulose - for confusion, causes loss of toxins via gut
IV mannitol - for reduced consciousness, reduces ICP
rifaximin - for prevention of recurrence
pruritus + pale stool + dark urine = what kind of jaundice
obstructive jaundice
iif a pt has jaundice and breathlessness (but no smoking history and bronchodilators are ineffective) what os the most likely cause
low serum alpha 1 antitrypsin
describe the microscopy results of ascitic tap for SBP
neutrophil count > 250 /uL
treatment for SBP
IV ceftriaxone / ciprofloxacine / cefotaxime
how many hours after abstinence from alcohol does delirium terms occur
48 - 72 hrs
what are the LFTs and other blood results for alcoholic hepatitis
AST>ALT (2:1)
elevated GGT
non megaloblastic macrocytic anaemia
increased ALP (but less than ALT and AST)
increased bilirubin
decreased albumin
increased PT
if have a pt who smells of alcohol, has signs of chronic liver disease and seems very confused, what’s the first investigation
blood glucose to rule out hypoglycaemia , then do LFTs
symptomatic relief of alcohol withdrawal
chlordiazepoxide
vitamin C
prevention of wernickes encephalopathy
pabrinex (IV thiamine)
what medications are given following successful alcohol withdrawal
Acamprosate - for abstinence
Disulfiram
Naltrexone
which autoimmune hepatitis occurs in children only
type 2
what is the most common type of autoimmune hepatitis
type 1
antibodies for type 1 A.I hepatitis
anti smooth muscle antibodies (ASMA)
anti nuclear antibodies (ANA)
antibodies for type 2 A.I hepatitis
anti liver kidney microsomal 1 antibodies
(anti LKM1)
antibodies for type 3 A.I hepatitis
anti soluble liver antigen
what is a sensitive markers for ischaemic hepatitis
significant rise in LDH
what is the highest LFT in viral hepatitis
ALT (ALT >AST)
describe the serology results in AI hepatitis
high IgG (hypergammaglobulinaemia)
ANA / ASMA / A-LKM1 / anti-solube liver antigen antibodies
which hepatitis is characterised by high IgG
auto immune hepatitis
treatment for AI hepatitis
Induction therapy : prednisolone (corticosteroid)
Maintenance therapy : azatioprine (immunosuppressant)
which hepatitis present predominantly in young/midddle aged women
autoimmune hepatitis
with class of antibody indicates previous or chronic infection
IgG
which class of antibody indicates current / acute infection
IgM
most common viral hep in developing countries
hep A
most common viral hep globally
hep B
causes of viral hepatitis
ABCDE ACE
Hep A
Hep B
Hep C
Hep D
Hep E
Adenovirus
CMV
EBV
what virus causes hep a / b /c / e
Hep A = RNA picarnovirus
Hep B = hepadnavirus
Hep C = RNA flavivirus
Hep E = calcivirus
which hep virus is asymptomatic
hep c
with which hep virus do most people develop chronic infection
hep c
hep a / b / c mode of transmission
a = faecal - oral
b = blood/body fluids
c = blood/body fluids
with which hep virus do most people develop jaundice
hep a
(some adults do with hep b, hep c is usually asymptomatic)
what is the serology of someone with chronic hep b infection with high viral replication
positive anti HBcIgG antibodies
positive hepB antigen
positive HBeAg
positive HBsAg
which Hep B antibody indicates previous vaccination
antibody against HbsAg
which Hep B antibody indicates previous infection
IgG antibody against HbcAg
which Hep B antigen indicates high infectivity / high viral replication
HbeAg
1st and 2nd line treatment for hep B
1st = Peginterferon, alpha 2a
(interferon alpha)
2nd = Tenofovir, Entecavir
treatment for hep c
DAAT
nucleoside analogues eg sofosbuvir+ ribavirin
characteristic symptoms of ascending cholangitis
charcots triad
RUQ pain
Fever
Jaundice
what is fibrosis
fibrosis of liver tissue into regenerative nodules
what causes palmar erythema in cirrhosis
increased oestrogen
what causes leuchonychia in cirrhosis
low albumin
what causes caput medusae in cirrhosis
portal HTN
what is fetor hepaticus and what is it a sign of
rotten eggs/garlic smelling breath
sign of liver cirrhosis
clinical signs of liver cirrhosis
palmar erythema
dupuytren contracture
caput medusae
spider naevi
fetor hepaticus
pruritus
plantar erythema
gynaecomastia
jaundice
oesophageal varices
oedema
ascites
splenomegaly
smaller liver
what is the most specific and sensitive test for liver cirrhosis
liver biopsy
what is done in liver cirrhosis every 6 months to screen for hepetocellular cancer
liver ultrasound
AFP levels
what is done to check for varicies in pts with liver cirrhosis
upper GI endoscopy
how to mange ascites due to liver cirrhosis
sodium restriction
spironolactone
paracentesis
what surgical procedure can treat portal hypertension to reduce the risk of oesophageal varices
TIPS (transoesophageal intrehepatic porto systemic shunt)
what treatments are required if a pt with liver cirrhosis has haematemesis / malaena
terlipressin (vasopressin analogue)
IV Abx
Vit K / FFP (PT>20) / blood or platelet transfusion
what med is used as a prevention to reduce recurrence of hepatic encephalopathy
rifaximin
triad of liver failure
coagulopathy (INR > 1.5)
jaundice
encephalopathy
what treatment is given for paracetamol overdose leading to liver failure
N -acetylcysteine
what does asterixis in liver failure indicate
hepatic encephalopathy
prophylactic Abx for SBP
ciprofloxacin or norfloxacin
how long after last drink does delirium tremens occur
48-96 hours
which tumour marker is used for hepatocellular carcinoma
AFP
what is the most likely diagnosis of someone with COPD and liver cirrhosis
alpha - 1 - antitrypsin deficiency
what is the number of units per day and the audit score baseline for recommending assisted alcohol withdrawal (eg chlordiazepoxide)
over 15 units per day
AUDIT score of over 20
what type of bilirubin is high in gilbert’s syndrome
unconjugated bilirubin
what do you measure to confirm diagnosis of Wilsons disease
ceruloplasmin levels
likely diagnosis in a 22 year old with jaundice, tremor, affected speech
Wilsons disease
what is a subacute history with tender hepatomegaly and ascites suggestive of (pt has had no recent travel and doesn’t drink)
liver ischaemia due to budd chiari syndrome
investigation for Budd chair syndrome / liver ischaemia
US liver with Doppler flows
what is the serum copper level in Wilsons disease
LOW - bc copper is deposited the tissues
what vitamin deficiency causes wernickes encephalopathy
vitamin B1 (thiamine)
triad of werncikes encephalopathy
ataxia
confusion
opthalmoplegia
first line treatment for Wilsons disease
penicillamine
(remember like “copper Penny”)
what is the LFT results for AI hep
raised ALT and AST compared with ALP
which type of bilirubin can be found in the urine
conjugated bilirubin - as this is water soluble
which type of bilirubin is high in Gilberts syndrome
unconjugated bilirubin - only yellow skin and sclera not poo/pee
which gene mutation is responsible for Gilberts syndrome
UGT1A1 gene
initial step if pt took paracetamol overdose more than 15 hours ago
start N acetyl cysteine immediately
initial step if pt took paracetamol overdose 4 - 15 hours ago
check blood paracetamol conc and commence treatment accordingly
what are the 3 situations where you should start N acetyl cysteine immediately for paracetamol overdose
- staggered overdose
- if ingestion was more than 15 hours ago
- if there is uncertainty about timing
pathophysiology of delirium tremens
unopposed glutamate activity
what is the LFT results in non alcoholic fatty liver disease
mild increase in AST and ALT
how do you diagnose non alcoholic fatty liver disease
liver biopsy
what is Budd chiari syndrome
obstruction of hepatic veins (often by thrombosis)
- hepatomegaly
- ascites
- abdo pain
for paracetamol ingestion, what Ph would indicate immediate liver transplant
pH < 7.3 at 24hrs post ingestion
what is naloxone used for
to treat and reverse opioid toxicity
how do you reduce risk of renal impairment in pts with SBP
give HAS (human albumin solution)
give 2 contraindications to performing an ascitic tap
infection on skin overlying area intended to insert needle into
disseminated intravascular coagulopathy
how do you calculate SAAG (serum-ascites albumin gradient)
serum albumin - ascites albumin
what are the causes of ascites if SAAG > 11 g/L and what type of ascites is it
ascites is transudative (low albumin)
causes:
portal HTN
liver cirrhosis
alcoholic liver disease
liver failure
Budd-Chiari syndrome
congestive heart failure
what are the causes of ascites if SAAG < 11 g/L and what type of ascites is it
ascites is exudative (high protein)
causes:
MIPN
- malignancy / malnutrition
- infection (eg TB)
- pancreatitis
- nephrotic syndrome
treatment for ascites
dietary sodium restriction
spironolactone
ascitic tap / paracentesis (give Iv albumin when doing large volume paracentesis)
AbX for SBP prophylaxis (ciprofloxacin / norfloxacin)
2 main side effects of spironolactone
gynaecomastia and hyperkalemia
wheat do you give for ascites if the max dose of spironolactone isn’t working
add furosemide to the spironolactone
what to give during large volume paracentesis
IV albumin
initial investigation of ascites
abdo USS
sign on examination suggesting ascites
shifting dullness
treatment of oesophageal varices due to portal HTN
terlipressin + IV Abx
consider TIPS (transjugular intrahepatic portosystemic shunt)
Prophylactic Beta blockers
what is raised in ascitic tap for SBP
neutrophils
what suggests SBP in an ascitic tap
ascitic fluid white cells > 250/mm3 which are predominantly neutrophils (PMN - polymorphonuclear neutrophils)
or
ascitic fluid contains neutrophils > 250/mm3 neutrophils
what is raised in ascitic tap for intra abdominal malignancy
lymphocytes
what is constipation defined as
irregular bowel movements
=< 3 bowel movements per week
give 3 groups of medication that cause consitpation
CCBs
antipsychotics
opiates
what is primary and secondary constipation
primary = due to dehydration, low fibre diet, lack of exercise
secondary = due to diverticulosis, diverticulitis, haemorrhoids, bowel obstruction, IBS etc
treatments for consitaption
1st: dietary and lifestyle modifications (more fluids, fibre exercise)
Bulk laxatives and tool softeners
Osmotic laxatives - eg lactulose
stimulant laxatives - eg senna
prunes - natural laxatives
what are the 4 main types of laxatives
bulk laxatives
osmotic laxatives
simulant laxatives
stool softener laxatives
when might constipation cause confusion
faecal impactation
bristol stool chart (type 1 -7)
1 - hard lumps, like nuts
2 - sausage shape but lumpy
3 - sausage shape with cracks on surface
4 - smooth sausage
5 - soft blobs, clear cut edges
6 - fluffy pieces, ragged edges, mushy
7 - watery, no solid pieces
investigations for constipation
anal manometry
FBC - ion deficiency anaemia
TFTs - hypo thyroidism
AXR - rectal mass, faecal impactation
Rome IV diagnostic criteria for functional constipation in adults
- at least 2
- in the past 1/4 or more of defections
- in past 12 weeks
- with symptoms ongoing for 6+ months
- 3 or less bowel movements per week
- sensation of incomplete evacuation
- sensation of anorectal obstruction / blockage
- manual aid to evacuate stool
- straining attempts to defecate
- hard/lumpy stool
constipation red flags in children
meconium passage delayed (over 48 hours)
consitpation within first month of life
bilious vomiting
blood in stool
fever
family history of related disease
severe abdo distention
constipation red flags in adults
family history
iron deficiency anaemia
blood in stool
palpable ado mass
reduced stool caliber
weight loss
recall prolapse
sudden onset
unresponsive to medication
>50 years
what counts as chronic anal fissure
over 6 weeks
primary vs secondary anal fissure
primary - due to local trauma
secondary - due to underlying disease eg previous anal surgery, IBD, infections
acute anal fissure management (<1 week)
conservative
- fluids
- diet modifications
- bulk forming laxatives and stool softeners
- lubricant / petroleum jelly application prior to defacation
- sitz bath
chronic anal fissure (>6 weeks)
analgesia
- topical GTN
- topical diltiazem
for persistent fissures
- botox
or surgical sphincterectomy
grades I - IV for internal fissures
I - bleeding, no prolapse
II - prolapse, reduces spontaneously
III - prolapse, can be technically reduced
IV - prolapse, cannot be reduced
internal vs external sphincter
internal - above denate line, painlesss
external - below denate line, can be painful and prone to thrombosis
how can you tell if a haemorrhoid is thrombosed
v painful
purple
oedematous
1st line diagnostic investigation for haemorrhoid
anoscopic examination (protoscopy)
1st line management for all haemorrhoid patients
dietary and lifestyle modifications
management for haemorrhoid grades I - IV
I = topical corticosteroids (relives pruritis)
II-III = Rubber band ligation
IV = surgical haemorrhoidectomy
which class of proteins triggers coeliac disease
gliadin
which skin manifestation is seen in coeliac disease
dermatitis herpetiformis
(itchy papulovesicular lesions on extensor surfaces of skin esp elbows)
1st line and gold standard diagnostic investigations for coeliac disease
1st line : serology
- increased IgA tTG / anti-endomysial / anti-gliadin antibodies
after that do Endoscopy + biopsy (diagnostic, gold standard)
- crypt hyperplasia / villous atrophy / increased intraepithelial lymphocytes
treatment for coeliac disease
avoid gluten - eat alternatives
vitamin and mineral supplements (as coeliac disease causes malabsorption)
which vaccination is give to those with coeliac disease and why
pneumococcal vaccination
they get functional hyposplenism
FBC finding for coeliac disease
iron deficiency anaemia
Blood smear finding for coeliac disease and what does this indicate
target cells
Howell-jolly bodies
indicates functional hyposplenism
what effect does coeliac disease have on the spleen
causes functional hyposplenism
most important sign suggestive of IBS
pain relieved by defecation
which extra intestinal manifestation runs its course independent of IBD activity (active luminal disease)
primary sclerosing cholangitis
what medication is used to maintain remission in UC in those who’s remission is not maintained by 5 ASA
mercatopurine or azothioprine
what investigation is done to monitor for complications of coeliac disease
DEXA scan –> monitors for osteoporosis / osteopenia
which area is always affected in UC but often spared in crohns
rectum
what type of laxative is macrogol
osmotic
what is the first line investigation for coeliac disease in a pt who his IgA deficient
blood test for anti tTG IgG antibodies
(normally its for anti tTG IgA antibodies)
first lien med for crohns flare up
IV hydrocortisone
pt with crohns presents with pain and fresh red bleeding on defecation. what is the most likely diagnosis
anal fissure
which part of the intestine is affected by crohns disease and contributes to the formation of gallstones
terminal ileum
what is imatinib used to treat and what is its mechanism of action
chronic myeloid leukaemia
GI stromal tumours
inhibition of tyrosine kinase
which investigation differentiates IBS from IBD
faecal calprotein
what does positive faecal elastase indicate
chronic pancreatitis
what do cysts on stool microscopy indicate
parasitic infection eg giardiasis
what type of condition does high ALP compared to ALT/AST indicate
obstruction
what does jaundice, pruritis and an obstructive LFT pattern in a pt with UC indicate
primary sclerosis cholangitis
LFT results in PSC
obstructive pattern
- v high ALP compared to AST/ALT
MRCP results in PSC
multiple beaded biliary structures
what do you need to rule out if someone with coeliac disease presents with weight loss / recurrent diarrhoea / recurrent abdominal pain
enteropathy associated T cell lymphoma
treatment for PSC
- supportive
- liver transplant, is potentially curative but PSC can recur
which condition does pain relieve by defecation indicate
IBS
pt with opiate - induced constipation has been taking movicol (osmotic laxative) to no effect. what is next step in management
ADD Senna
best treatment for opiate-induced constipation
a combination of an osmotic and a stimulant laxative
in which pts should stimulant laxatives be avoided
pts with
- small bowel obstruction
- IBD
- pregnant
initial management in a euvolemic pt with toxic megacolon
urgent decompression with an NG tube
which conditions is hcg raised in
hydatidiform moles
choriocarcinoma
gestational trophoblastic tumours
what is VMA (vanillylmandelic acid) raised in
phaechromocytoma
which condition is CA19-9 raised in
cholangiocarcinoma
which condition is CA125 raised in
ovarian cancer
what do raised faecal leukocytes indicate
bacterial infective colitis
what is a common defecation problem in enterally fed pts
diarrhoea
what is the likely diagnosis if a pt with long-standing UC develops abnormal liver enzymes and weight loss
cholangiocarcinoma / biliary tract carcinoma
crohns pt is on steroid therapy, which med should she be put on to prevent crohns flare
azothioprine
pt underwent a bowel resection for their crohns and is now suffering with pale coloured and difficult to flush diarrhoea. what is most likely diagnosis
short bowel syndrome
what is blepharitis and what is it most commonly caused by
inflammation of eyelid - red, crusty
caused by staph aureus infection
when is tacrolimus used to treat UC
when pt is resistant to aminosalicylates and steroids
what is used to maintain remission in UC pts
azathioprine
if pt has an acute uC flare up and topical +oral mesalazine is not improving symptoms what do you add
add prednisolone
what medication is used to maintain remission in both uc and crohns
azathioprine
if colonscopy is normal in a pt with crohns, whats the next step in investigation
investigate the small bowel:
- small bowel MRI or small bowel capsule endoscopy
what is loperamide used for
to treat diarrrhoea
so don’t give in constipation !!
give some iatrogenic causes of diarrhoea
oral magnesium replacement, penicillin, omeprazole, metformin, chemotherapy, NSAIDs
most likely cause of hairy-looking white lesion on side of tongue
epstein barr virus
likely diagnosis if a pt presents with weight loss, bloody diarrhoea, high ALP and positive p-ANCA and ANA
primary sclerosing cholangitis (secondary to UC)
what are sore swollen tongue (glossitis), bleeding gums and peripheral neuropathy a sign of
B12 deficiency
order of treatments for UC flare up
- IV hydrocortisone
- cyclosporin
- infliximab
- colectomy
first line test for coeliac disease suspicion
total IgA + IgA tTG
if crohns pt presents with sepsis secondary to a perineal abscess, what is first line of investigation
urgent MRI pelvis
(if delay - urgent CT, if not possible - examination under anaesthetic)
what kind of laxative is ispaghula husk
bulk forming
what kind of laxative is macrogol
osmotic laxative
what kind of laxative is bisacodyl
stimulant laxative
what is a likely diagnosis for abdominal pain, explosive diarrhoea, bloating and flatulence after tropical travel
giardia
what do pale stools (steatorrhea) indicate
malabsorption
if a pt meets IBS criteria, what is the most appropriate next investigation
tTG antibodies, to rue out coeliac disease
what indicates surgery with toxic megacolon
not responds to steroids within 48-72 hrs
toxic megacolon treatment
NBM
IV fluids
IV hydrocortisone
which cause if diarrhoea shows ancathocytes, target cells and Howell jolly bodies on a a blood film
coeliac disease
in which conditions should pts also be tested for coeliac disease
graves disease
T1DM
first line treatment for flare up in crohns
prednisolone
what is shilling test used for
evaluates whether or not vit B12 deficiency is caused by pernicious anaemia
treatment for dermatitis herpetiformis
dapsone
what do aphthous ulcers in the context of weight loss and abdo pain indicate
crohns
if pt is in an acute condition/having a flare up and was suspected to have IBD (blood in stool is already seen), what is the best diagnostic investigation
flexible sigmoidoscopy
(colonoscopy can cause perforation in flare up)
what is chlorhexidine used to treat
oral ulcers
what is fluconazole used to treat
oral thrush , candidiasis
what is the ABC of IBS
abdominal pain, bloating, change in bowel habit for at least 6 months
rome IV criteria for IBS
on average at least 1 day/week, during past 3 months, 2 of the following
- pair related to defecation
- change in stool frequency
- change in stool form/appearance
according to NICE, those who meet criteria for IBS should be tested to rule out which other condition
coeliac disease - test for anti tTG antibodies
management for cramps/pains associated with IBS
antispasmodics
management for constipation dominant IBS
bulk forming laxatives (ispagula husk / Fybogel)
avoid lactulose
management for diarrhoea dominant IBS
Loperamide (antidiarrhoeals)
where is the pain in UC
left lower abdomen
where is the pain in crohns
right lower abdomen
contrast the diarrhoea in UC vs crohns
UC: bloody, mucus
Crohns: non bloody, watery
contrast the main symptoms a right vs left sided colorectal carcinoma
right: melena, diarrhoea
left: constipation
contrast colon layer involvement in UC vs crohns
crohns: transmural
UC: mucosa
contrast the most commonly affected parts of gut in UC vs crohns
Crohns: terminal ileum
UC: rectum
contrast granuloma involvement in UC vs crohns
crohns: non caseating granulomas
UC: no granulomas
contrast involvement pattern in UC vs crohns
crohns: skip lesions
UC: continuous
contrast smoking effects in UC vs crohns
crohns: smoking = Risk factor
UC: smoking = protection
contrast joint involvement in UC vs crohns
crohns: arthropathy (joint pain)
UC: ankylosing spondyliis, pyoderma gangernosum
what are the effects on the skin and eyes in UC and crohns
skin:
erythema nodosum (erythema on shins)
pyoderma gangrenosum (ulcers on legs)
mouth ulcers
eyes:
anterior uveitis (painful red eye with loss of vision and photophobia)
episcleritis (painless red eye)
(in UC, episcleritis>anterior uveitis)
what shows on a barium enema in crohns
kantor’s string sign
rose thorn ulcers
what does a biopsy show in crohns
skip lesions
deep ulcers
cobblestone appliance
transmural inflammation
non caveating granulomas
increased goblet cells
1st line treatment for crohns flare up
predinsiolone
treatment in crohns
induce remission:
prednisone / budesonide
maintain remission:
1st line: azathioprine (may cause myelosuppresion, reducing WCC)
2nd line: methotrexate
Bioogics
side effect of azothioprine
myelosuppression, may cause WCC reduction
next steps if crohns colonsoscipy is normal
investigate small bowwel by either
- small bowel capsule endoscopy
- MRI small bowel
what is proctitis
UC involving only rectum
what is pancolitis
UC involving entire colon
which parts of the gut can UC be found in
uptown the ileocaecal valve - never spreads proximally to this
does crohns or UC have genetic element, and what is the genetic element
UC
genetic predisposition - HLA-B27